Clinical Approach to Substance Abuse Disorders

Question 1

Substance Use DO’s

Answer 1

Maladaptive patterns of a specific substance use that leads to impairment in occupational, physical, and/or social functioning

Question 2

Substance-Induced DO’s

Answer 2

Intoxication and Withdrawal disorders

Question 3

What are the NIAAA definitions of at-risk drinking for Men and Women

Answer 3

Men- >14 drinks per week or >4 per sitting

Women- >7 drinks per week or >3 per sitting

Question 4

If a patient states they drink 3 beers a day but show signs of alcohol abuse, what should you assume?

Answer 4

They drink more like 5-6 beers a day. Usually patients under-report

Question 5

What demographic of people have the highest rates of alcohol abuse

Answer 5

Native Americans

Question 6

What is defined as Alcohol Abuse?

Answer 6

2 of the following for 12 months: 
EtOH in larger amounts for an ext. time more than intended 
Persistent desire to cut down 
Excessive time spent obtaining EtOH
Cravings
Doesn't care about other areas of life

Question 7

Tolerance

Answer 7

Increased amount of alcohol needed to achieve results

Question 8

What are some symptoms of EtOH withdrawal

Answer 8

Autonomic Hyperactivity (lethal)
Tremor
Insomnia
NV
Hallucinations
Seizures

Question 9

CAGE questions

Answer 9

Feel like you should Cut down?
Annoyed at criticism of drinking?
Guilty about drinking?
Early-morning drinking to get through the day?

Question 10

Effects of EtOH by system

Answer 10

Liver- fatty, cirrhosis, hepatitis
GI- Varices, ulcers, pancreatitis
CV- Dilated myopathy, CVA’s

Question 11

What is Delirium Tremens?

Answer 11

Tremors
Delusions
Hallucinations
Seizures

Question 12

EtOH Detox Treatment

Answer 12

Benzo
Antipsychotic (Haloperidol) 
Fluids 
Vitamins (Thiamine, folic acid)
Restraints if necessary

Question 13

What type of therapy is preferred for alcoholic dependence?

Answer 13

CBT (apparently usually the answer on a test/boards)

Question 14

Acamprosate

Answer 14

Pharmacological approach to maintaining abstinence from alcohol. Reduces voluntary ingestion by potentially inhibiting GABA in the CNS and antagonizing the receptor similarly to EtOH

Question 15

Naltraxone

Answer 15

opioid antagonist used to cut cravings

Question 16

Disulfiram

Answer 16

Will cause a person to become sick if they ingest alcohol (disulfiram reaction)

Question 17

What might you see on CBC in an alcoholic patient?

Answer 17

MCV>100 (B12/B9 def.)

Thrombocytopenia

Question 18

4 things you can include in an IV infusion for initial management of an alcoholic patient

Answer 18

1. Thiamine
2. Glucose
3. Multivitamins
4. Folic Acid

Question 19

In an Amphetamine/Cocaine OD, what happens to the pupils?

Answer 19

Mydriasis (dilation)

Question 20

How do individuals on Sympathomimetics withdraw?

Answer 20

Eat and Sleep

Usually withdrawal is not lethal.

Question 21

Treatment for a Sedative/Hypnotic Abuse OD

Answer 21

Protect Airway
O2 Admin
Ventilation
Keep warm

Question 22

2 Hallucinogen substances

Answer 22

LSD
PCP

Causes: Dilated Pupils, Tachy, HTN, Hallucinations, Violent Behavior

Question 23

How do you treat a hallucinogen OD?

Answer 23

Diazepam

Haloperidol

Question 24

What happens to the pupils in an Opioid OD?

Answer 24

Miosis (Constricted)

Question 25

What can be given for withdrawal of opioids?

Answer 25

Buprenorphine (Mu agonist/K ant)
Methadone
Naloxone

Question 26

A person on Molly presents to the ER with confusion and an ALOC. What might a friend say happened after she took the drug?

Answer 26

She was chugging water (Psychogenic Polydipsia). This patient could be hyponatremic